1164013140 NPI number — KEYSTONE ALLERGY AND ASTHMA CENTER PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164013140 NPI number — KEYSTONE ALLERGY AND ASTHMA CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE ALLERGY AND ASTHMA CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164013140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/18/2021
NPI Reactivation Date:
07/31/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 EXTON CMNS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-897-7143
Provider Business Mailing Address Fax Number:
484-328-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 EXTON COMMONS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-890-9990
Provider Business Practice Location Address Fax Number:
610-890-9991
Provider Enumeration Date:
02/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GHELANI
Authorized Official First Name:
SUJAL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
484-897-7143

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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